Characterization and treatment outcomes of biologic therapy in super-responders and biologic-refractory psoriasis patients: A single-center retrospective study in China.

Abstract

Background: Despite advances in the availability of effective biologics in psoriasis over the past decade, clinical characteristics, persistence, and safety associated with treatment response have never been systematically investigated.

Objectives: To evaluate the factors, persistence, and safety associated with super response (super-responder, SR) or refractory (biologic-refractory patient, BRP) to biologic agents.

Methods: This retrospective analysis included psoriasis patients who initiated their first biologic therapy. Multivariable logistic regression analysis identified predictors for SRs and BRPs. Drug survival used Kaplan-Meier plot analysis.

Results: 737 patients were included (140 SRs [19.0%], 34 BRPs [4.6%]). Body mass index (BMI) <25, lower Charlson Comorbidity Index, without psoriatic arthritis, with family history of psoriasis, and lower insulin resistance level were significantly associated with SRs, whereas BMI ≥30, with non-alcoholic fatty liver disease, higher psoriasis area and severity index, and higher erythrocyte sedimentation rate level were independent predictors of BRPs. SRs were associated with treatment persistence of biologics, but BRPs were linked with poor persistence and higher incidences of adverse events-particularly paradoxical eczema.

Limitations: Single-center study with limited patients.

Conclusion: Our study identified predictors of response that may facilitate accurate drug targeting with good persistence and reassuring safety for psoriasis patients.